I witnessed the most horrible death last night at a LTC facility.

[stdntograd06]

As the title states, I had a death last night (the second night in a row to be exact) and I'll be at peace if I never have to watch someone die like that again.

This gentleman was approx. 85'ish, and in respiratory failure, and on Hospice. He had a foley catheter draining blood-tinged urine that just started going pink on the 3-11 shift, and a GT tube running at 65ml/hr. After I started the 11-7 shift, on initial assessment, he was quiet and his relatively stable self. He was given his 2400 ABHR gel and his tube flushed without difficulty. At 0145, on rounds, I was notified by the CNA to go to his room. Before I even got to his room, I heard the most horrible gurgling sounds. He was in definite respiratory distress and hyperventilating. I stopped the tube feeding, gave him Atropine gtts for the secretions at 0150 and told the CNA to stay with him and use the swabs to clear some of the secretions. Note: He had no order to suction (it is contraindicated with Hospice). I called my Supervisor and informed her of his status, that he was literally drowning in his secretions. She said she would be right there and call hospice, but that they wouldn't do anything. You could just hear tons of secretions sitting right in his throat and esophagus. He was unable to expectorate anything, and just choking on all of it.

He was due to recieve routine Roxanol 20mg (1 ml) at 0200, so I gave that to him. The supervisor came over, took a look at him and call Hospice immediately to discuss further treatment. She said that suctioning is contraindicated and that she was on her way (30 minutes away). At 0215, we gave him Ativan concentrate. His HR was 138-142 and Resp's TNC. His abdomen was severly distended and firm (he had 2 med. BM's the day prior). You could see the fear in his eyes and face, looking right at us as if begging for help. One of the CNA's stayed with him comforting him while my supervisor was on the phone. She told me to go ahead and give him more Atropine at 0230 even though it was ordered every hour. It had only been 40 minutes since I last gave it to him. The CNA put the call light on a few minutes later and when I entered the room his face and hands were blue, fingernails were blue. His eyes were half open and I watched as the color and life just drained out of his face. He took his last breath at 0235.

2400- ABHR gel

0150- Atropine gtts

0155- Roxanol 20mg

0215- Ativan Concentrate

0230 Atropine gtts

0235- Took his last breath

We all took this very hard, especially since he suffered immensely his last 45 minutes on this earth. I thought Hospice was all about dying with dignity and peacefully, with comfort?? Where was the comfort here? Any thoughts and advice are needed at this time. I am emotionally drained after last night.

Kelly

[tattooednursie, LVN]

I really disagree with the hospices policy of not suctioning, but you don't want to loose your licence for not following policy. That is a very tough patient. You did the right thing with the atropine.

At least you were there for him. I think if he had went like that, it was just his time. You were there with him, and he did not have to go alone. I think that is the most important thing.

[Moneypitt]

That must have been hard to watch. But in the end most of those type of situations end up with people drowning in their own secretions. The difference in this case vs. a peaceful looking death is that this patient from what you described seemed very alert. This is one of the reasons when doing hospice in a hospital setting that I am glad they still have IV's or Butterfly SC access. Then you can give them enough Morphine and Ativan to make them comfortable and it actually works. For some reason it seems that the orals do not do enough, at least in my experiences with hospice patients.

[FranEMTnurse, CNA, LPN, EMT-I]

I witnessed this back when I was a nurses aide. In fact, it took one man 3 days to die. I can still his remember the nightmarish gurgling sounds every time he took a breath. That was before hospice care was even thought of. Sometimes I think it is better to allow the individual to die with no intervention except pain control. Hopefully that would shorten the dying process. I know I have a health care proxy, and it lets my physician know I choose to die at home. I have seen too much of the suffering when dying to last me the rest of my life. I even lived in a hospice house in the past, where numerous people died. Most died peacefully, or without very much struggle at all. I pray I will be one of them when it is my time to go.